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Transcript of Webcast (continued)

Dr. Daniel Dodgen: Thank you, Dr. Chung. I would now like to introduce Bill Modzeleski, the Acting Assistant Deputy Secretary at the Office of Safe and Drug-Free Schools (OSDFS) at the Department of Education. As I mentioned earlier today, he will review some of their school-based resources and related initiatives. OSDFS has developed numerous resources for schools on emergency management and has awarded hundreds of grants to school districts to support emergency planning and recovery efforts. Mr. Modzeleski?

Bill Modzeleski: Thank you Daniel, thank you Kelly, and thank you fellow panelists. I am Bill Modzeleski from the Office of Safe and Drug-Free Schools. It is the office in the Department of Education that is responsible for helping schools as well as institutions of higher education prepare for, respond to, and recover from incidents both large and small, which can impact teaching and learning. Today, I want to do three things. I want to give you a quick overview of where schools are regarding preparedness, where we want them to be, where we want them to go, and how we help them get there. I want to start by amplifying a little bit of what Dr. Chung said by putting the situation in context.

In the United States we have a very, very large school system. There are well over 55 million kids in schools and 15,000 school districts, which are both a variety of range and size from those which may have one school and 100 students to those that have over 1,000 schools and over a million students. Schools are also places that have a variety of students. It should be recognized that, in many districts, at least 10 percent to 20 percent are students with disabilities, and when we begin to develop plans, we have to account for the students with disabilities. Lastly, schools are also workplaces, and I think we forget often that they are not only places where teaching and learning take place, but they are workplaces.

To put this in context, when we were looking at what happens in schools, if you take the approximate number of students that there are, 54 million, and multiply it by the number of days that most students go to school, 180, you come up with about 9.83 billion student-school days. Mathematicians will tell you that it is a strange day when strange things do not happen in schools, not a strange day when strange things do happen in schools. We cannot tell you where they will occur or what it will be, or exactly when the incident will occur, but we can tell you that every day here in the United States, some strange things will happen. They could be a shooting, accident, bus accident, chemical spill, suicide, it could be a contagious disease, but every day something happens, and we need to be prepared to handle that.

So, where are schools when it comes to planning for issues or crises that might come up? Almost every school has a plan; 95 percent of the schools in this country have some sort of crisis plan, since this has been required since 2001 in the No Child Left Behind legislation. Also, I should say that every State has a pandemic flu plan, and this is a fact that not everybody knows, but there is not always great linkage between the State plans and the school plans. However, as we began to look at the school plan, what we discovered was as Dr. Chung said, they are not always comprehensive. They do not always deal with the potential crisis that can happen in school, and they are not practiced on a regular basis. Every school system in this country has a requirement to conduct fire drills, but few other States have any requirements beyond fire drills. Therefore, a lot of the other things that come up are not practiced on a regular basis. They are not coordinated with the community, and we have often said that schools do not exist in a vacuum. Schools have to be an integral part of the community, and they have to be a part of that, but they are not there yet. What we have seen with crisis plans is, too often, crisis plans are developed by the administration and placed on the shelf as what we call shelf documents, and they are not of much utility. They do not involve the partners that I mentioned earlier. This is dealing with the community, with first responders, with hospitals, with mental health, and other partners that we often neglect and also the students themselves and asking them and getting their cooperation in developing the plans, as well as their parents. Lastly, these plans are not individualized. Too often what happens is that plans are taken off the shelf and given to a school but are not individualized to the needs of the students or to the school.

So, where do we want every school in the country to be? We have 100,000 schools, 15,000 districts—where do we want these schools to be? First of all, we want every school in the United States to have a plan, and that plan has to address all four phases of crisis planning; prevention/mitigation, planning, response, and recovery. I should point out that, in our experience in dealing with schools since 2003 on the preparedness program side is that the phase that is the most difficult to get through to schools and to really work with schools is the third phase, the recovery phase. It is an extremely difficult part, and a lot of that comes from the fact that schools were not always linked with the mental health community and those other communities. Second, the plan should be based on sound data and information; this is conducting assessments, understanding what your problems are, and understanding what resources you have. That all drives what needs to be a part of the plan, and it has to be, as I mentioned earlier, a community plan, a plan based on the community and where the school is located in the community.

One thing we have not talked about is the development of an incident command system. Often times, where we see a shortcoming in schools is a lack of understanding about what an incident command system is and who is really in charge when a crisis happens. We need to get this understood because schools need to know beforehand when a crisis happens, who is in charge: the police department, fire department, the principal, all of this is key to a good incident command system. Lastly, these plans need to be reviewed and updated on a regular basis. What we discovered is that, too often, plans are put together as part of a mandate. Whether a State or Federal mandate, they are finished and put on a shelf and not dusted off until an incident occurs. If these plans are to be successful, if they are to be effective, they need to be reviewed and updated on a regular basis.

Okay, so, how are we going to get there? How are we going to move schools to where we really want them to be? I think the most important thing for us to understand is that preparedness and development of plans is not the primary part or the primary initiative of the school; the primary mission of schools is teaching and learning. If there is something that we can do, it is making preparedness a priority for schools, and the message that we have to say is if teaching and learning is going to take place, preparedness has to be a part of that. It is interesting that during the recent outbreak, Secretary Duncan emphasized the importance of healthy, safe students. The message was that we do want our schools to be safe places and that in order to do that, we need to make sure that for every school the priority is school preparedness.

Two, is that we are going to get there by continuing funding support. Since 2003, we have provided over $175 million dollars, we have over 600 school districts in this country that have revised or improved their overall crisis plans, and I think this is the basis for really establishing a cornerstone of our school system that is prepared. I should point out that 60 percent of the hundred largest school districts in this country have received funding and have crisis plans that have been successfully developed and developed with an acknowledgment of what the needs of the community are.

Three, is training and technical assistance. All of our districts that have received funding, all 600 of them, have received extensive training in the four phases of crisis planning. We are in the process of developing training modules that we will put online so that not only our grantees, but every school system in the country will have online training through Webinars. One of the more successful Webinars that we have developed deals with kids with disabilities and again, a clear understanding that many schools have anywhere from 10 percent to 20 percent of kids with disabilities, and how we deal with kids with disabilities is quite different than other individuals.

Lastly, are our publications, and there are a variety of publications on our Web site: publications, newsletters, lessons learned, and helpful hints.

In closing, what I want to say is that one of the things that we have learned from the recent pandemic issue is that there is a lot of information that we talk about regarding preparedness, specifically in targeted preparedness. What we discovered is that there is a lot of information that is not on any of the Web pages that deal with preparedness or education that are vitally important. One of the sites that is not up here that I would really like to bring people's attention to is http://www.free.ed.gov. If we are forced to close schools for an extended period of time, it will be sites like this that help educators gather information for instructional purposes. Thank you, very much.

Kelly Johnson: In a moment you will see the second poll question pop up on your screen. This poll asks, "What are your community's current priorities for emergency preparedness?" Please choose all that apply: Emergency Health Care, Primary Health Care/Continuity of Care, Home Health Care Services, Palliative Care, Surge Capacity, Resource Allocation, Staffing, Transportation, Alternate Care Sites, Disease Surveillance, Communication, School Safety/Violence Prevention, Pediatric/Child Care. Please take a moment to fill out your response. If you are unable to respond to the polls during this event, please E-mail your answers to emergencypreparedness@academyhealth.org.

Dr. Daniel Dodgen: I would now like to introduce Mr. Revere. Christopher Revere is the Executive Director of the National Commission on Children and Disasters, which is funded by Congress. Mr. Revere will discuss the Commission's purpose, process, and recommendations. Mr. Revere?

Christopher Revere: Thank you, Dan. Good afternoon. I guess the first question on a lot of folks' minds is why form a national commission on children and disasters? I guess if the information that has been provided on this call already was not convincing enough, I would offer up some additional evidence that the Commission has uncovered in its deliberations and its research. First and foremost, it has been expressed in different ways, but children make up a significant part of our population in this country—25 percent of the general population are kids under the age of 18, and everyone on this call, I think, agrees that they have unique needs that need to be met. I think it also calls into question something that I just thought of, which is, depending on the emergency and on the disaster, kids can quickly become the majority of the population affected. If we think about the H1N1 flu outbreak, and we look at some of the numbers that CDC has collected, upwards of 58 percent of the confirmed cases in this country were children and adolescents under the age of 18. I think it impresses, even more, the fact that we do need to have specific planning and preparedness in place for kids. They can quickly become a significant part of an affected group, depending on the disaster or the public health emergency. There are also some other important aspects in the literature that I think need to be discussed in this forum. A number of studies over the last 3 or 4 years have looked at how prepared we are as a Nation to deal with kids in disasters and again very sobering information.

GAO did a study that showed that only 20 State child welfare agencies had written disaster plans in this country. A University of Arkansas study surveyed 13,000 pre-hospital emergency medical services nationwide and found that only 13 percent had specific disaster plans for children. Save the Children, last year, put out a report, and I understand that they have another one coming in the near future, showing that only four States require basic emergency preparedness requirements for schools and child care facilities. I think, in terms of the discussion today and the gaps in preparedness that have been presented, it is even more stark when you consider that over the last two decades, according to the Federal Emergency Management Agency, FEMA, the number of presidential disaster declarations are up 47 percent in that time. In fact, it used to be an average of 38 declarations in this country in the 1980s, and now it is up to 56 per year here in 2000, and already in 2009 we have had 25 presidentially declared disasters, so it sounds like we will maintain the growth of those declarations.

Just quickly, an overview of the Commission. As Dan described, it was created by Congress by law and is an independent commission, which means that it reports directly to the President and to Congress. It also means that the Commission's work is free from the influence of Federal or State and local agencies. There are 10 members that have been appointed to serve on this Commission. The President—President Bush—had two appointees, as did Republican and Democratic congressional leaders, so it is a bipartisan commission. The expertise on the Commission is drawn from a number of different disciplines: we have three pediatricians; we have a number of State and local emergency managers; we have two non-governmental organizations dedicated to children represented, as well as a member of the Nevada State Legislature. Our Commission is chaired by Mark Shriver of Save the Children, and the vice-chairman is Dr. Michael Anderson of University Hospital—he is a pediatrician.

The objectives of the Commission are to examine and assess children's needs across all hazards, across the continuum of preparedness, response, and recovery. We are to identify, review, and evaluate existing laws, regulations, policies, and programs, and also to evaluate lessons learned from past directors. As I mentioned, the Commission will report its findings directly to the President and Congress. We have a very ambitious agenda with a broad number of issue areas—everything from trauma, physical, and mental health of kids to child welfare, child care, housing, sheltering, to intermediate and long-term needs, evacuation, and transportation, elementary and secondary education, juvenile justice, as well as State and local emergency management issues.

Some important milestones for the Commission. Our first public meeting was in October of last year. We have had, since then, three public meetings held in Washington, DC. We have also had a field hearing in Baton Rouge, and we also have a summer public meeting coming up in June in Washington, as well as a public meeting in the fall. Then we have our interim report due in October of 2009 and our final report due in October of 2010.

Just a couple areas of primary interest. Again, we have tried to break these out into easy areas to try to handle since the Commission's work is so broad. Under preparedness and response, given that we have such a pediatric presence on our Commission, we do have a Pediatric Medical Care Subcommittee. A number of issues revolve around that, including the emergency use authorization for off-label use and mechanisms to develop, stockpile, and distribute pediatric medical countermeasures. We are also very concerned about the need for pediatric presence on disaster medical response teams, as well as the people on those teams being trained, equipped, and supported. Also, what I think has been a theme of this discussion is to ensure that kids are made a priority in State and local emergency plans. Finally, in terms of mental health needs of kids, to make sure the psychological first aid training programs are put in place to increase resilience for responders, schools, and the community, so that people are trained and ready to deal with the mental health needs of kids.

In the area of long-term recovery, which is a very important issue to the Commission because it is typically within the continuum of preparedness response and recovery—the area that receives the least amount of attention—we are working very closely with the Obama administration to make sure that kids are a priority in the development of a national recovery framework. We would also like to see the adoption of a more holistic disaster case management model, working very closely with FEMA and HHS on that. By holistic, I mean to go beyond just meeting the housing or economic needs of children and families, but making sure that the health and human services needs are being met for kids as well. Then, in terms of some of the emergency support functions within government, ESF #14, which is long-term recovery, tends to focus mostly on rebuilding assets, such as bridges and roads, and we are trying to make health and human services more of a priority within ESF #14 to realize that. Specifically, when it comes to the Stafford Act there are a couple of areas that I think need to be given consideration and made a priority for kids, whether it is the rebuilding of day care centers, schools, or safe play areas.

Finally, again, just to put a recap on what we have heard so far, the needs of kids are overlooked, and there are several reasons why. At least in the Commission's study, we believe that is true. First, is most of the trainings, medicine, and equipment are really intended for the general population. Typically, kids are lumped into other broad categories either by law or by regulation. They are considered at-risk, vulnerable, or special needs. I think from the Commission's viewpoint, we consider kids unique, and perhaps they need to be given their own consideration in that regard. Kids need to be more of a priority in disaster planning that goes everywhere from the Federal level down to the State and local level and, when we think of recovery, we need to think more about restoring lives rather than just rebuilding roads and bridges. Finally, I think the Commission has a great interest in accountability. Ultimately, when we have these disasters, and whether it is a category five hurricane or a flu outbreak or something more localized within the community, kids need to have advocates, whether in the White House,Governor's offices, or Federal/State agencies that are responsible for kids just to make sure there is someone there making a very clear case for kids to the executive levels of government. Thank you, very much.

Kelly Johnson: Thank you, Mr. Revere. Now, we would like to start the Q&A session that Dr. Dodgen and I will moderate. If you would like to pose a question to any of our presenters, please type your question into the Q&A panel on the right side of your screen, then click the send button.

Dr. Daniel Dodgen: Due to the large number of questions we have received in a short period of time, we will ask our speakers to keep their responses brief so we can respond to as many questions as possible. Our first question is for Dr. Chung. The question is: What programs or suggestions would you use to train the community emergency department to be able to care for children?

Dr. Sarita Chung: Thank you, Dan. That is a great question. The first thing you have to realize in community emergency rooms or in general emergency rooms, the ones where Dr. Boyer practices, you really need to look at your inventory and make sure that you have adequate pediatric equipment. Children range in size from an infant to a teenager. At the bare minimum, you should make sure that you have equipment for all sizes in order to care for children of different sizes. Secondly, think about contacting your pediatrics staff if you feel there is not as much pediatric input so that they can give guidance on treatment and care. Lastly, think about a memorandum of understanding to your children's tertiary care sites so that you will have a direct place where you would send your children that require more specialized care. Thank you.

Kelly Johnson: Thank you. Our next question is for Dr. Upperman. Is there a psychological impact on children who are involved in drills, such as having a SWAT team come into the school with guns, etc.?

Dr. Jeffrey Upperman: That is a very interesting question, Kelly. I am not a mental health specialist. As you know, I am a pediatric surgeon, so we just say "cut it out." The reality is there might be some impact, but most kids, when they see people running around with special uniforms and guns and the fire department come in, they actually think it is pretty cool. I think if you did the appropriate briefing and debriefing with the children and their parents, who may be in attendance at your drills, I think they will do okay. You really need to set up the day and make sure they get a holistic experience.

Kelly Johnson: Very good. Thank you. Dan?

Dr. Daniel Dodgen: For the next question, I would like to start with Bill, but anyone can respond. What do you suggest in planning for displaced children and/or orphaned children during emergencies?

Bill Modzeleski: That is a great question. I want to go back to the fact that, when we talk about schools and planning for schools, we talk about community planning. This is not just about school planning. Schools can do their part about making sure that the schools are open and they are educated, but this is an issue where you need to work with local service providers and local officials to make sure they are taken care of. Schools have a part of it, but it is not the entire picture.

Dr. Daniel Dodgen: Would anyone like to add something? Okay, let's go on to the next question, Kelly.

Kelly Johnson: Thanks, Dan. Can the presenters talk about the deployment of mental health professionals as part of their team response? This is open to the entire panel.

Dr. Jeffrey Upperman: We have psychologists and psychiatrists as part of our Pediatric Disaster and Resource Training Center in Los Angeles County, and, in fact, we are working very closely with the Los Angeles Emergency Medical Services system in developing programs and demonstration projects to look at these professionals and how they are deployed. We also are working with faculty from the University of California Los Angeles in looking at mental health triage implements in our disaster exercises. So mental health is very much a part of our team, and they are involved in every aspect of our planning.

Dr. Daniel Dodgen: Thanks, Jeff. The next question is for Ed. What arrangements are or should be made for the use of schools in surge situations? How might we use schools in order to enhance our surge capabilities?

Dr. Edward Boyer: What is true of all surge events is how to use any structure, whether temporary or permanent, as a way to decant or offload patient volume into a safe environment. For example, if you had a population that was relatively unaffected, they could be sent to schools. They also could, alternatively, be sent to tents that were set up in parking lots, they could be kept in cafeterias, or other large conference rooms in a medical center. I think the application for it is a way to offload relatively unaffected individuals into a safe environment.

Bill Modzeleski: Dan, if you do not mind, one of the issues for schools is, what we have seen is that you cannot do things to schools without notifying the schools of what you are doing. If you put people in schools and do not tell school officials about that, essentially what you are doing is displacing students from the educational environment. This gets back to the whole issue of preparedness being a community response. It is a two-way street. It is the schools working with the community, but it is also the community working with the schools.

Dr. Daniel Dodgen: That is a really good point. The next question is for Dr. Chung. Regarding your recommendation for student medications to be transported in evacuation and relocation, do you recommend taking all medications or only those that are used for emergencies? For example, would you want the school nurses or others to bring along the ADHD medications and other things, or are you really just talking about emergencies?

Dr. Sarita Chung: I think, ideally, you would say everything, but when you really look at the situation when you need to evacuate, I think the emergency drugs take priority. That is a little bit of a complex situation because not all schools have dedicated school nurses. Those that do not need to think of alternative ways, such as their teachers understanding children's medical histories and needing emergency medication.

Kelly Johnson: Very good. Thank you, Dr. Chung. This question is for Bill. Funding to schools for emergency planning has been mentioned by all of the speakers. Is there a specific grant for schools to apply to receive these funds?

Bill Modzeleski: Yes, there is. It is actually known as REMS, Readiness Emergency Management for Schools. The good news is that we are going to make grant awards in fiscal year 2009 totaling about $35 million dollars. The other good news is that starting in fiscal year 2008, we also made awards to institutions of higher education. For these institutions, it is lesser money, but they are both available. In fiscal year 2010, it is in the President's budget, so we assume that opportunity will be available again. It is closed for fiscal year 2009 but will reopen again in 2010.

Dr. Daniel Dodgen: Thank you, very much. These are really wonderful questions. The next question is for Chris Revere. Does the Commission lean towards family practice as the lead approach to pediatric care outside of DMATs, Disaster Medical Assistance Teams, in disasters with an expectation of compromised patient loads during many incidents such as hurricanes, epidemics, or flooding? Do I need to repeat the question?

Christopher Revere: It is a very complex question probably even for some of the more adept on our panel. Right now, the Commission is in a situation where it is gathering information and talking about it within the subcommittees that have been formed. We do have a Subcommittee on Pediatric Care, and I think what I would do is take that question back to our pediatric experts. I am not sure if the Commission is going to be making recommendations at that level of granularity, but I do think that, working with Dr. Upperman, who does serve on our Subcommittee, could probably help provide some guidance in that area.

Dr. Jeffrey Upperman: Dan, I will take a shout out at that one and pay homage to your boss; as we know he is a family practice doctor, and of course they are a very important part of the medical fabric that would help respond to any crisis. We need all doctors and nurses and other allied health professionals to stand up. I may need a respiratory therapist who, in essence, would be my working pulmonologist if there is no pulmonologist available, and I need as much expertise as they can put on the table to respond. I might need an adult oncologist to become that pediatric oncologist if those pediatric oncologists are not available to help us with trying to do chemotherapy in a parking lot somewhere. I think what we are really talking about is trying to manage during the impossible in a way that makes the most sense with the resources that we have available. It will take flexibility, teamwork, and communication.

Dr. Edward Boyer: If I could add one other thing, I think it gets back to kind of what I tried to highlight in my talk about how clinicians need to, perhaps, step outside of their normal bounds of practice and adopt some leadership and true responsibility for patient care. Emergency physicians and those in acute medical environments are used to handling things that are not necessarily that comfortable to them, but in an all-hazards situation with lots of patients coming in, triage rules apply, which means that if you are not comfortable with doing something, nonetheless, it is time to step up.

Dr. Daniel Dodgen: That is very helpful. Thanks. Also, to all the panelists, if you could please say your name when your respond so that the people listening know who is responding.

Kelly Johnson: Thanks, Dan. This question is for Dr. Upperman. Is it possible to access or get a copy of SurgeWorld, Dr. Upperman's surge capacity video game, and other resources developed by PDRTC?

Dr. Jeffrey Upperman: The Pediatric Disaster Resource and Training Center has a whole host of implements, and, actually, Dr. Chung came and joined us during our family reunification workshop that we had back in the spring. All of those are available at www.chladisastercenter.org. What I am told by our gaming people is that the final version will be up shortly. We have just been doing the beta testing, and it is looking great.

Dr. Daniel Dodgen: Thanks. That is very helpful. The next question will be for Bill or Sarita, and it is really a two-part question. The first part is: Is there an emergency preparedness manual specifically developed for daycare settings? And the second, related question is: Are there other, larger preparedness manuals that include a section in them for either preschools, private, or public daycare settings?

Bill Modzeleski: Let me start, and then Dr. Chung can pick it up. What we discovered is that there are some very basic principles that need be applied, whether it is a nursery, school, preschool, a K-12 school, or an institution of higher education. These principles can be found in our Emergency Crisis Manual that is posted online. That provides very much some of the same things that Dr. Chung made in her presentation, some of the key principles that every institution, whether it is an institution of higher education or preschool, needs to address. What is not in there are some of the specifics related to very young children.

Dr. Sarita Chung: I have to agree with Bill and would say that there is no regulation of daycares to have emergency response manuals. Some are mandated by States, but some States do not. I think that, as Bill said, some of the same principles for schools and higher learning apply. For the younger children, you want to try to think about tracking and identification and how you would unify them with their families.

Kelly Johnson: Thank you, Dr. Chung. The National Association of School Nurses [NASN] has been involved in preparing school nurses in disaster preparedness planning and execution. To what extent have schools and the NASN been involved in preparedness efforts? That is for Bill, Sarita, and the entire panel.

Bill Modzeleski: Let me, first of all, give out thank yous to all of the school nurses that worked tirelessly over the last several weeks with the issues related to the flu. We work very closely, not only with the Association, but with a lot of the front-line nurses that struggled mightily through this event. I can say that testimony provided last week in the House Committee from Jack O'Connell, who is the State Superintendent of Schools in California, acknowledged the fact that there is a need for many, many more school nurses. One, is their need. Two, is that they are working tirelessly in the field, and thanks to them. We have worked closely with school nurses, and we are continuing to work with them. We clearly understand that we will not be successful or effective without the help and cooperation of the school nurses.

Kelly Johnson: Very Good. Dan?

Dr. Daniel Dodgen: I think this might be our last question. Let's open it up to the whole panel. When there is a lockdown in a school where students go to more than one classroom, does anyone have suggestions for caring for students with such conditions such as diabetes other than depending on students to carry emergency supplies. I think the question is really: What thinking has gone into caring for children with chronic medical conditions in the event of a lockdown, where they are not able to move around and access all of the medications that they might need?

Bill Modzeleski: I will start with the 30,000-foot level and then draw it down to the local level, maybe. This is one of the things that I kept on mentioning is that we have 10 percent or 20 percent of our school population that have disabilities of a variety that need medications; peanut butter allergies, autism, etc. All of these things need to be taken into consideration when schools develop their plans; this is why we can't have one plan for the entire school district. This is why every single school district needs to take these things into consideration as they talk about lockdowns and evacuations, and a lot of times kids will have the potential to be evacuated for a long period of time. Is guidance out there? Yes, guidance is out there. Are schools following it? For the most part, we hope they are. It is very difficult, but there is guidance on what to do regarding these students.

Dr. Daniel Dodgen: Would anyone else like to respond? Sarita?

Dr. Sarita Chung: I agree with Bill. This is a very difficult question, and that is why each school should take a look at their particular population. Some suggestions have been made for children to carry their own medications in case they need to be suddenly departed from the building or to be locked in. As Bill said, each school should really look at their population and see what their health/chronic medical needs are and disabilities are to come up with an adequate plan.

Dr. Daniel Dodgen: Do any of our pediatric hospital people want to weigh in on how they might contribute to that type of plan?

Dr. Jeffrey Upperman: Absolutely. The Pediatric Disaster Resource and Training Center recently collaborated in a disaster response event with the L.A. Unified School District, and it was amazing across all kind of schools with different densities of children with special needs. They all performed very well. The school that had a high density of special needs kids, it was like clockwork, very well organized, and it was clear that the families had plans and were used to dealing with circumstances that were not usual. I think that some of our families may be better prepared than some of our systems, and we should take note and bring them to the table when talking about our system-wide plans.

Dr. Daniel Dodgen: Thanks, Jeff, and thanks to all of the panelists. Thank you to everyone that listened in; again, there were over 700 of you. The questions were all excellent, and unfortunately, we do not have time to get to all of them because our time is now almost up. If we did not answer your question today, you can E-mail us at emergencypreparedness@academyhealth.org. That is the same address that was on your screen earlier.

We hope that the information presented today raised your awareness of the critical physiological and psychological differences between children and adults. Based on today's presentations, you can see these differences have generated considerable momentum in the preparedness field to find best practices to address the needs of children. Additionally, we hope that you come away from today's event with a better understanding of the Federal resources that are currently available to emergency preparedness practitioners representing State, local, tribal, and other agencies, emergency responders, and school personnel. Each of our presenters recommended excellent resources that we encourage everyone to review. In addition, the Agency for Healthcare Research and Quality's four resources are listed here. The last two listed were not mentioned during today's Web conference. Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians is a practical resource that pediatricians can consult in planning for and responding to natural disasters and bioterrorist events. Decontamination of Children: Preparedness and Response for Hospital Emergency Departments is a 27-minute video that demonstrates for emergency responders and hospital emergency department staff how to safely decontaminate children who have been exposed to hazardous chemicals, including those from a bioterrorist attack.

Kelly Johnson: Thanks, Dan. As we conclude this Web conference, let me remind you that information about AHRQ's Public Health Emergency Preparedness resources are available at AHRQ's Web site, http://www.ahrq.gov/prep/. The archived materials from today's event will be posted in a few weeks.

That brings us to the conclusion of the event. Thank you to our audience for your thoughtful questions and for joining us for this event. We would also like to thank our presenters, Dr. Boyer, Dr. Upperman, Dr. Chung, Mr. Modzeleski, and Mr. Revere for sharing their expertise in pediatric emergency preparedness today. I would also like to thank Dr. Dodgen for sharing ASPR's work with us and co-moderating this event with me.

Dr. Daniel Dodgen: Thank you, Kelly. It was a pleasure.

Kelly Johnson: Finally, when you close your screen, you will see a feedback form. Please take a few minutes to complete this form. Your feedback is important for the development of future AHRQ emergency preparedness activities.